Informed consent for a person with a psychiatric disorder

Seek consent from the person before starting treatment for a psychiatric disorder. Issues for clinicians to consider when assessing consent to treatment in a person with a psychiatric disorder are outlined in Issues to consider when assessing a person’s capacity to provide consent to treatment.

For a person’s consent to be valid, it must be given without coercion and in accordance with the relevant local policies and legislation. The person must have adequate decision-making capacity to provide consent (ie ability to give informed consent to a particular decision at a particular time) and have been provided with adequate information to enable them to reach and communicate an informed decision about their treatment (see Shared decision making for a person with a psychiatric disorder). Even if the person lacks the capacity to provide informed consent, they should be involved in the process of consent. Equally, it is important to engage the person in treatment decisions, even if they are receiving involuntary treatment in accordance with relevant mental health legislation. When safe and feasible, a person’s treatment decisions should be supported even if they do not align with what is considered optimal care.

When people with psychiatric disorders have capacity to consent, they should be able to provide or withdraw consent to treatment freely and without coercion. If the person lacks the capacity to consent to certain treatments, they may still be able to provide consent on other matters.

If there are concerns about the person’s capacity to provide consent and a particular treatment is considered necessary, refer to the relevant State or Territory legislation for information on who can provide consent (see also Resources for informed consent in a person with a psychiatric disorder). If urgent intervention is required and it is not possible to obtain consent, the principle of ‘duty of care’ may be used as a rationale for medical intervention without obtaining consent. If in doubt, consider the likely consequences of not intervening—consult a senior colleague whenever possible.

A person’s capacity to provide informed consent may fluctuate over time. Capacity to provide informed consent should be reviewed periodically and appropriate action taken to ensure that consent continues to be valid.

Figure 1. Issues to consider when assessing a person’s capacity to provide consent to treatment
  • Capacity is a person’s ability to provide informed consent to a particular treatment decision at a particular time.
  • Legislation outlines that a person is assumed to have capacity to consent, unless it is demonstrated otherwise.
  • State and territory legislation describe the requirements a person must meet to have capacity to consent to a particular treatment decision. These may include:
    • they understand the information provided to them about the treatment
    • they can remember the information
    • they can use the information to weigh up the benefits and harms and to consider alternate treatment options
    • they can communicate their decision.
  • Capacity to provide informed consent may fluctuate over time.
  • Support should be provided to a person to assist them to understand and remember the information about the proposed treatment. This may include using language the person can understand or visual aids (eg written or pictorial information).
  • If possible, time should be allowed to consider and discuss options with significant others, family or carers, other healthcare providers and the clinician.
  • If possible, assessment should take place at a time and place that is most amenable to an accurate assessment of capacity (eg in a quiet place when the person is rested and relaxed).
  • If a person lacks capacity to make a particular decision at a particular time:
    • the decision may be deferred if not urgent or it is anticipated that the person may gain capacity later
    • the person’s views and preferences should be taken into account as much as possible, and the person should be given the opportunity and support to participate in the decision-making process, if possible (see Shared decision making for a person with a psychiatric disorder)
    • the views and preferences in any advance care directive, and the views of any nominated significant other, family member or carer, must be taken into account when reaching a decision.
  • Decisions regarding a capacity assessment should be documented in the medical record.
Figure 2. Resources for informed consent in a person with a psychiatric disorder
  • Australian commission on safety and quality in health care: Informed consent fact sheet for clinicians [URL]
  • The Royal Australian and New Zealand College of Psychiatrists: Capacity of adults to give informed consent to psychiatric treatment in Australian and New Zealand Mental Health Acts [URL]
  • Capacity Australia website